Shi A, Zheng J, Wu D
… +9 more, Yang X, Jiang Z, Chen X, Zhang W, Sun W, Lin J, Cheng J, Dong Q, Shen X
Int J Colorectal Dis
· 2025 Nov · PMID 41254407
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PURPOSE: To compare perioperative outcomes and safety between the novel single-port robotic systems (SPRS) and the da Vinci Xi robotic system (DVRS) in radical colorectal cancer resection. METHODS: In this retrospective...PURPOSE: To compare perioperative outcomes and safety between the novel single-port robotic systems (SPRS) and the da Vinci Xi robotic system (DVRS) in radical colorectal cancer resection. METHODS: In this retrospective cohort study, 59 patients who underwent curative colorectal resection were assigned to either the SPRS group (n = 21) or the DVRS group (n = 38). Intraoperative metrics, postoperative recovery parameters, and complications were compared between groups. RESULTS: All procedures were successfully completed without open conversion and the number of lymph nodes harvested was comparable. The SPRS group demonstrated significantly longer operative times (298.86 ± 76.08 min vs. 227.84 ± 70.20 min; p < 0.001). No significant differences were observed in estimated blood loss, time of gastrointestinal recovery(first flatus), time of dietary resumption (liquid/soft diet), or 30-day readmission rates (p > 0.05). The DVRS group exhibited prolonged median postoperative hospitalization (10.00 days [IQR 8.00-11.75] vs. 8.00 days [IQR 7.00-9.00]; p < 0.05). Patients in the SPRS group reported significantly higher satisfaction scores regarding the cosmetic appearance of postoperative scars compared to those in the DVRS group(7.71 ± 1.01 vs. 6.66 ± 0.91; p < 0.001). Complication rates showed no statistical difference (p > 0.05). All complications were Clavien-Dindo grade I-II managed conservatively, except one SPRS case requiring endoscopic intervention for grade IIIa gastrointestinal hemorrhage. CONCLUSIONS: The novel single-port robotic systems are safe and feasible for radical colorectal cancer surgery. They achieve short-term outcomes comparable to the da Vinci Xi system, with the advantages of a shorter hospitalization and better cosmetic outcomes but at the expense of a longer operative time.
Los B, Rocha BA, da Silva DN
… +9 more, Ribeiro VM, Kohara MA, Rodrigues RA, Pintão MCT, Pereira OJE, de Morais Malvezzi JV, da Silva FH, de Souza PHA, Araújo DC
Int J Colorectal Dis
· 2025 Nov · PMID 41251828
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PURPOSE: Early colorectal cancer (CRC) detection is crucial for effective treatment; however, traditional screening methods face challenges. Colonoscopy, though highly effective, has limited availability, and fecal immun...PURPOSE: Early colorectal cancer (CRC) detection is crucial for effective treatment; however, traditional screening methods face challenges. Colonoscopy, though highly effective, has limited availability, and fecal immunochemical tests (FIT) are more accessible and cost-effective but suffer from low adherence. Our retrospective study aimed to develop a transparent artificial-intelligence model leveraging routine CBC data as a cost-effective method for CRC detection. METHODS: We conducted a retrospective analysis of 28,450 individuals aged 45-75 who underwent colonoscopy within six months of a complete blood count (CBC) test. Among them, 439 (1.8%) had CRC, 2,955 (11.8%) had advanced adenomas, and 21,662 (86.5%) had benign findings on colonoscopy. The database was divided into training (70%) and testing (30%) sets. The model was developed using ridge regression. RESULTS: Descriptive analysis revealed significant differences between CRC cases and controls across most CBC markers, CBC-derived ratios, and age (P < 0.001), except for lymphocytes. The model, based on red cell distribution width (RDW), systemic inflammation response index (SIRI), hemoglobin, and age, achieved an AUC of 0.77 (95% CI: 0.75-0.77) for CRC, comparable to a deep learning model (TabPFN). Interpretability analysis revealed that older age, elevated RDW and SIRI, and low hemoglobin were associated with CRC. In a subgroup (7.25%) with FIT results, FIT showed higher sensitivity for CRC (88%) than the model (64%), but lower specificity (77% vs. 81%). CONCLUSION: Given CBC's widespread use and accessibility, this approach may be a scalable pre-screening tool to improve CRC risk stratification and optimize resource allocation, demonstrating how explainable AI may augment existing CRC screening programs.
Bulut A, Akın Mİ, Görgülü V
… +4 more, Zorlu FN, Karpuz Ş, Coşkun M, Yeğen C
Int J Colorectal Dis
· 2025 Nov · PMID 41249563
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PURPOSE: Antibiotic therapy may be an alternative in the treatment of uncomplicated appendicitis. The primary concern about antibiotic therapy is the need for appendectomy due to recurrent acute appendicitis after treatm...PURPOSE: Antibiotic therapy may be an alternative in the treatment of uncomplicated appendicitis. The primary concern about antibiotic therapy is the need for appendectomy due to recurrent acute appendicitis after treatment. The optimal antibiotic choice, route of administration, and duration of treatment remain controversial. We aimed to demonstrate the long-term success of oral antibiotic therapy in uncomplicated appendicitis. METHODS: This was a single-center retrospective study including all patients diagnosed with uncomplicated acute appendicitis between January 2020 and December 2022, who were discharged from the emergency department on oral antibiotics without hospitalization. Treatment success was defined as the absence of appendectomy during follow-up. We reported long-term treatment success rates of oral antibiotic therapy. In addition, factors that may affect treatment success were evaluated. RESULTS: A total of 99 patients were included in the study. At 1 year, the treatment success rate was 76% (95% CI = 66-83%). At a median follow-up of 34 months, 70% (95% CI = 60-78%) remained free of surgery. The Kaplan-Meier analysis revealed that 80% of appendectomies due to recurrent acute appendicitis occurred within the first 10 months. There were no significant differences between patients who required appendectomy and those who did not regarding age, sex, WBC count, neutrophil-to-lymphocyte ratio, appendix diameter, or previous intravenous antibiotic use. CONCLUSION: With a median follow-up of 34 months, oral antibiotic-only treatment prevented appendectomy in 70% of patients. Larger, prospective randomized studies are needed to identify factors influencing treatment success.
Celik CE, Chalabiyev E, Gurler V
… +4 more, Onur MR, Şahin TK, Dizdar O, Ozmen F
Int J Colorectal Dis
· 2025 Nov · PMID 41243024
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PURPOSE: The study aims to evaluate the correlation between visceral adiposity, fatty liver, and survival in patients with metastatic colorectal cancer (mCRC). METHODS: The study included 131 adult patients with treatmen...PURPOSE: The study aims to evaluate the correlation between visceral adiposity, fatty liver, and survival in patients with metastatic colorectal cancer (mCRC). METHODS: The study included 131 adult patients with treatment-naive mCRC. The visceral and liver fat content was measured using baseline computed tomography (CT) images. The analysis used the 50th percentile (131.80 HU) visceral adiposity value as a cutoff. The visceral and liver fat content association with patient characteristics and outcomes was assessed. RESULTS: In the overall cohort, neither visceral adiposity (median OS 37.8 vs 36.7 months, HR = 0.83; p = 0.428) nor liver steatosis (median OS 46.0 vs 33.9 months, HR = 0.81; p = 0.370) showed significant association with OS. However, in patients with BMI ≥ 25 kg/m, liver steatosis was associated with significantly shorter survival (median OS 35.2 vs 59.5 months; adjusted HR = 0.49; p = 0.040). Visceral adiposity remained non-significant across BMI subgroups. CONCLUSION: We observed a possible association between liver steatosis and OS in patients with mCRC in the high BMI subgroup. Prospective studies are essential to validate these findings and the role of liver steatosis in the prognostic assessment of mCRC patients.
Zhang H, Yu S, Xiang J
… +11 more, Mongardini FM, Docimo L, Huang Z, Wang G, Wang Y, Liu Y, Wang C, Zhang W, Zhu Y, Wang G, Wang M
Int J Colorectal Dis
· 2025 Nov · PMID 41242993
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PURPOSE: Current diagnostic modalities lack sufficient sensitivity for detecting omental metastasis (OM), often underestimating metastatic burden. Unlike traditional statistical model, machine learning (ML) model is desi...PURPOSE: Current diagnostic modalities lack sufficient sensitivity for detecting omental metastasis (OM), often underestimating metastatic burden. Unlike traditional statistical model, machine learning (ML) model is designed to detect subtle variable interactions and model nonlinear patterns that traditional statistics overlook, enhancing the reliability of OM risk evaluation in clinical practice. The aim of the study was to build a ML model in preoperatively predicting OM in right-sided colon cancer (RCC) patients using a multicenter dataset. METHODS: This retrospective multicenter study included 1798 RCC patients: 1206 from Zhejiang Cancer Hospital (training set n = 804, test set n = 402) and 592 from the Second Affiliated Hospital of Harbin Medical University (validation set). OM status, tumor location, preoperative CEA level, preoperative CA199 level, Grade, histology, tumor size and age of patients were recorded. Six ML models including extreme gradient boosting (XGB), artificial neural network (ANN), logistic regression (LR), random forest (RF), support vector machine (SVM) and decision tree (DT) were developed for the OM prediction in RCC. The area under the receiver operator characteristic (ROC) curve (AUC), accuracy, sensitivity, specificity, precision, F1 score and decision curve analysis (DCA) were analyzed for judging predictive performance. RESULTS: The OM rates in training set, test set and validation set were 10.4%, 9.5% and 10.0%, respectively. The XGB model outperforming five other algorithms (ANN, RF, LR, SVM, and DT) across training set (AUC = 0.924, 0.096 gain vs LR), internal test (AUC = 0.868, 0.038 gain vs LR) and validation set (AUC = 0.766, 0.065 gain vs LR). The comparison of accuracy, sensitivity, specificity, precision and F1 score revealed the XGB model exhibited the best performance. The DCA curve also suggested that XGB had better clinical decision-making capability than the other five models. Feature importance analysis highlighted preoperative CEA level and tumor location as key predictors. CONCLUSION: Our study developed and validated an XGB-based machine learning model that could accurately predict OM in RCC patients using routine preoperative variables. This model demonstrates strong discriminative ability and clinical utility, assisting personalized risk stratification and appropriate treatment decisions.
Tatar C, Bisgin T, Canda AE
… +13 more, Karakayali F, Gecim E, Yildirim AC, Cetinkaya E, Cakcak IE, Ozata IH, Koc MA, Aydin HO, Bozbiyik O, Kozan R, Sevim Y, Erenler Bayraktar I, TSCRS Study Group
Int J Colorectal Dis
· 2025 Nov · PMID 41231265
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PURPOSE: Treatment strategies for early and locally advanced rectal cancer are evolving, particularly with the increasing use of non-operative management and multidisciplinary decision-making. The aim of this study is to...PURPOSE: Treatment strategies for early and locally advanced rectal cancer are evolving, particularly with the increasing use of non-operative management and multidisciplinary decision-making. The aim of this study is to establish an expert-based consensus on the preferred treatment strategies for early and locally advanced rectal cancer. METHODS: A 12-member steering committee was established to conduct a modified Delphi consensus process on rectal cancer management. The committee performed a systematic literature review (2014-2024) to inform survey development. A 49-question survey, including open-ended and multiple-choice items, was developed and refined. A panel of 44 colorectal surgery experts was selected based on academic contributions, and two Delphi rounds were conducted anonymously. Consensus was defined as ≥ 70% agreement. Based on panel responses, 29 consensus statements were formulated. RESULTS: The panel reached consensus on the importance of multidisciplinary evaluation and surgical expertise in total mesorectal excision. Structured MRI reporting was recommended. Total neoadjuvant therapy was preferred for high-risk tumors. Non-operative management was recommended in cases of clinical complete response, with defined surveillance strategies. The role of biopsy in near-complete responders was also addressed. CONCLUSIONS: This international consensus provides structured guidance on the management of rectal cancer, emphasizing multidisciplinary planning, the role of total neoadjuvant therapy in organ preservation, and rigorous surveillance protocols in non-operative management. These recommendations aim to standardize care and support evidence-informed clinical decision-making.
Naghavi M, Nikkhah Bahrami K, Ghane Y
… +4 more, Ezzatollahi Tanha A, Ahmadi F, Nikkhahbahrami N, Jalilvand A
Int J Colorectal Dis
· 2025 Nov · PMID 41219445
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BACKGROUND: Colorectal cancer (CRC) is a prevalent and deadly malignancy, often characterized by cellular heterogeneity and resistance to therapy. CD133, a proposed cancer stem cell marker, has been implicated in poor cl...BACKGROUND: Colorectal cancer (CRC) is a prevalent and deadly malignancy, often characterized by cellular heterogeneity and resistance to therapy. CD133, a proposed cancer stem cell marker, has been implicated in poor clinical outcomes, but its prognostic value remains controversial, particularly in diverse populations. OBJECTIVE: This study aimed to evaluate the relationship between CD133 expression and overall survival (OS) in patients with colorectal adenocarcinoma treated at Mousavi Hospital in Zanjan, Iran. METHODS: This retrospective cohort study analyzed 55 patients who underwent surgical resection for histologically confirmed colorectal adenocarcinoma between 2012 and 2017. CD133 expression was assessed using immunohistochemistry (IHC) and categorized as positive or negative. Associations with clinicopathological features and 5-year survival were examined using logistic regression and Cox proportional hazards (PH) models. RESULTS: CD133 expression was detected in 47.3% of tumors. It was significantly more prevalent in high-grade tumors (83.1% vs 18.7%, p = 0.001) and in female patients (66.7% vs 32.2%, p = 0.015). Five-year survival was significantly lower in CD133-positive patients (19.2%) compared to CD133-negative individuals (75.9%, p < 0.001). In multivariable Cox regression adjusted for tumor grade and age, CD133 positivity was associated with increased hazard of death (adjusted hazard ratio(HR) = 5.03; 95% confidence interval (CI) 1.66-15.25; p = 0.004). Because of the modest sample size and wide confidence intervals, this association should be considered preliminary. In crude analyses, tumor grade impacted survival; in the adjusted model, only CD133 remained remarkable, while age, sex, and tumor location showed no significant associations. CONCLUSIONS: CD133 expression is significantly associated with high tumor grade and poor survival in Iranian CRC patients, but findings should be interpreted with caution, given the small cohort. Its evaluation could aid in identifying high-risk individuals and guiding personalized treatment strategies in larger confirmatory studies.
Yalcinkaya A, Yalcinkaya A, Sahin C
… +10 more, Balci B, Ozeller E, Ozturk E, Kayacan GS, Karaca BE, Oyanik AF, Yavuz A, Kamer E, Leventoglu S, PISI TURKEY Study Collaboration
Int J Colorectal Dis
· 2025 Nov · PMID 41217517
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Dahouri A, Hosseinzadeh M, Gilani N
… +1 more, Sahebihagh MH
Int J Colorectal Dis
· 2025 Nov · PMID 41207890
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BACKGROUND: Colorectal cancer (CRC) significantly impacts health-related quality of life (HRQoL) and sexual function (SF) in patients, with these effects potentially varying by gender. Despite the growing prevalence of C...BACKGROUND: Colorectal cancer (CRC) significantly impacts health-related quality of life (HRQoL) and sexual function (SF) in patients, with these effects potentially varying by gender. Despite the growing prevalence of CRC in Iran, the gender-specific relationship between HRQoL and SF remains underexplored. This study aims to investigate the association between HRQoL and SF in CRC patients in Iran. METHODS: A descriptive-correlational study was conducted among 256 CRC patients recruited from oncology centers in Iran through convenience sampling. Participants were assessed using validated and reliable instruments, including a researcher-developed demographic questionnaire, the Short Form-36 (SF-36) for HRQoL, the Female Sexual Function Index (FSFI) for women, and the International Index of Erectile Function (IIEF) for men. The normality of the data was evaluated using kurtosis and skewness indices. Pearson's correlation coefficients and partial correlation analyses were employed to examine the associations between HRQoL and SF, adjusting for potential confounders. Data were collected and subsequently coded using Stata software (version 17, StataCorp, College Station, TX). RESULTS: In this study, 256 colorectal cancer patients (50.4% male, 49.6% female) were analyzed, with a mean age of 50.2 ± 20.4 years. Significant associations between HRQoL and sexual function were primarily observed in female patients. In women, strong positive correlations were found between the physical functioning domain of HRQoL and both sexual satisfaction (r = 0.78, p < 0.001) and sexual pain (r = 0.87, p < 0.001). Additional significant correlations included HRQoL physical functioning and sexual desire (r = 0.53), mental stimulation (r = 0.53), lubrication (r = 0.59), orgasm (r = 0.59), and the total FSFI score (r = 0.69) (all p < 0.001). In contrast, no comparable correlations were found in male patients. Energy levels were positively correlated with sexual function in females but negatively in males (e.g., energy/fatigue and sexual satisfaction, r = - 0.67, p < 0.001), further underscoring gender-specific differences. Social functioning was positively associated with sexual pain (r = 0.54, p < 0.001) and other FSFI domains in women. General HRQoL was also positively correlated with sexual function in women (e.g., total HRQoL and sexual satisfaction, r = 0.56, p < 0.001) but not in men. These findings highlight a clear gender disparity in the interplay between HRQoL and sexual function. CONCLUSION: In conclusion, this study identifies complex, gender-specific associations between HRQoL and sexual function in colorectal cancer patients. Among female patients, better physical functioning and higher energy levels were associated with greater sexual satisfaction, whereas these associations were not observed in male patients, suggesting potential gender differences in sexual health outcomes. In both genders, higher social functioning was positively associated with sexual health, underscoring the possible role of social support. These findings highlight the relevance of considering gender-specific factors when addressing quality of life and sexual health in this population; however, due to the cross-sectional design, causal relationships cannot be inferred. Future research employing longitudinal designs is warranted to better understand the directionality and potential causal pathways of these associations.
Sakamoto A, Sasaki K, Abe H
… +12 more, Kikuchi R, Nozawa H, Murono K, Emoto S, Yokoyama Y, Nagai Y, Abe S, Shinagawa T, Tachikawa Y, Okada S, Ushiku T, Ishihara S
Int J Colorectal Dis
· 2025 Nov · PMID 41204004
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BACKGROUND: It has been suggested that chemoradiotherapy may cause fibrosis of the internal anal sphincter, resulting in sclerosis. However, no report has quantitatively investigated this relationship by using real-time...BACKGROUND: It has been suggested that chemoradiotherapy may cause fibrosis of the internal anal sphincter, resulting in sclerosis. However, no report has quantitatively investigated this relationship by using real-time tissue elastography. OBJECTIVE: To clarify the relationship between fibrosis and elasticity of the internal anal sphincter in patients undergoing surgery for lower rectal cancer with or without preoperative chemoradiotherapy from a histological perspective. DESIGN: A single-center, prospective cohort study. SETTINGS: The surgical and pathological departments in a tertiary referral university hospital. PATIENTS: Eighteen patients with rectal cancer who underwent abdominoperineal resection between May 2019 and May 2022 were included in the study. MAIN OUTCOME MEASURES: Real-time tissue elastography was performed before surgery to measure internal anal sphincter hardness as "elasticity" (hardest (0) to softest (255); decreased elasticity indicated sclerotic changes). Internal anal sphincter fibrosis was evaluated using Masson's trichrome and Elastica van Gieson staining. We evaluated internal anal sphincter elasticity after preoperative chemoradiotherapy and preoperatively in patients who did not undergo preoperative chemoradiotherapy and analyzed the correlation with the percentage of internal anal sphincter fibrosis in the resected specimens. RESULTS: Of the 18 patients, 10 underwent preoperative chemoradiotherapy. A significantly higher percentage of internal anal sphincter fibrosis was observed in the chemoradiotherapy group. Post-chemoradiotherapy elasticity was significantly lower in patients undergoing chemoradiotherapy compared to pre-chemoradiotherapy elasticity and that in patients not undergoing chemoradiotherapy. The analysis of the correlation between internal anal sphincter elasticity and fibrosis showed that elasticity decreased as the percentage of fibrosis increased. LIMITATIONS: This study was conducted at a single institution, and the number of cases was small. The radiation dose to the anal canal may have differed depending on the location of the tumor, which may have affected internal anal sphincter elasticity. CONCLUSIONS: Internal anal sphincter elasticity may reflect tissue sclerosis associated with fibrosis caused by chemoradiotherapy.
Chang TK, Ke TW, Hsieh PS
… +8 more, Chang SC, Hu WH, Huang CW, Chiang FF, Tsai HL, Liang JT, Liu CK, Wang JY
Int J Colorectal Dis
· 2025 Oct · PMID 41162746
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BACKGROUND: Establishing statements backed by strong scientific evidence with the intention of standardizing and guiding Hemorrhoidal Disease (HD) diagnosis and treatment in both the general population and in specific pa...BACKGROUND: Establishing statements backed by strong scientific evidence with the intention of standardizing and guiding Hemorrhoidal Disease (HD) diagnosis and treatment in both the general population and in specific patient groups is the aim of this consensus. METHODS: A consensus panel of 11 surgical specialists from the Taiwan Society of Colon and Rectal Surgeons was convened from July 2023 to October 2024. Using a modified Delphi methodology, the panel addressed the diagnosis, treatment, prevention, and special situations of HD. Experts responded to a pre-meeting survey, and a literature search of English-language studies on clinical judgment, pharmacologic treatments, and surgical interventions was conducted. Draft statements were developed, discussed, and refined during the first meeting in July 2023. In April 2024, the panel reviewed updated studies, finalized recommendations, and voted anonymously. An online meeting in October 2024 validated and approved the recommendations, which were graded using the GRADE system. RESULTS: A total of 9 consensus statements have been developed covering the diagnosis and management of HD. The general principle of this consensus statement is to follow most international guidelines. To tailor the local clinical practice, we also discussed the alternative treatment strategy for sclerotherapy, the use of traditional herbs/medicines, and the consideration of CRC screening test. CONCLUSIONS: These suggestions may represent a positive start toward recognized guidelines for improved hemorrhoidal disease treatment for all Taiwan healthcare professionals. As the first point of contact with patients, general practitioners, family medicine physicians, young surgeons, and pharmacists will find them to be quite valuable.
Saito A, Yokoyama Y, Uchino M
… +41 more, Ikeuchi H, Okabayashi K, Oka S, Higashi D, Ogawa S, Watanabe K, Shibutani M, Okita Y, Wakai T, Mizuuchi Y, Okamoto K, Yamada K, Sato Y, Ogino T, Kimura H, Takahashi K, Hida K, Kinugasa Y, Ishida F, Okuda J, Daito K, Yamamoto T, Yamamoto S, Koyama F, Hanai T, Komori K, Shida D, Arakaki J, Fujita F, Yamaguchi S, Ueno H, Matsuda K, Maemoto A, Nezu R, Sasaki S, Sunami E, Noguchi T, Sugihara K, Ajioka Y, Ishihara S, Study Group for Inflammatory Bowel Disease Associated Intestinal Cancers by the Japanese Society for Cancer of the Colon, Rectum
Int J Colorectal Dis
· 2025 Oct · PMID 41152600
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PURPOSE: Few studies have reported the association of macroscopic classification with clinicopathological characteristics and prognosis of ulcerative colitis-associated colorectal cancer (UC-CRC), unlike sporadic CRC. In...PURPOSE: Few studies have reported the association of macroscopic classification with clinicopathological characteristics and prognosis of ulcerative colitis-associated colorectal cancer (UC-CRC), unlike sporadic CRC. In this study, we aimed to clarify the clinical significance of macroscopic classification of UC-CRC. METHODS: The cohort included 480 patients with UC-CRC with invasion beyond the muscularis propria treated at 43 Japanese institutions between 1983 and 2023. The patients were divided into six groups based on the macroscopic type (types 0-5), and clinicopathological features and prognoses were compared. RESULTS: Among 480 patients, 66 (13.8%), 75 (15.6%), 116 (24.2%), 63 (13.1%), 68 (14.2%), and 92 (19.2%) had type 0-5 tumors, respectively. There were significant differences in the clinicopathological characteristics with a younger age in type 4 or 5 tumors than in type 2 tumors (p < 0.01) and a higher frequency of undifferentiated carcinomas (p < 0.01) and lymph node metastasis (p < 0.01) and more advanced depth of invasion (p < 0.01) in type 4 tumors than in type 1 or 2 tumors. Type 4 and 5 were independent risk factors for 5-year recurrence-free survival (p = 0.02; type 4 [HR: 6.35], type 5 [HR: 5.25]) and type 0, 4, and 5 for overall survival (p = 0.02; type 0 [HR: 4.51], type 4 [HR: 5.70], type 5 [HR: 4.02]). CONCLUSIONS: Type 0, 4, and 5 tumors were characteristic macroscopic types of UC-CRC and correlated with worse prognosis. Therefore, endoscopic diagnosis of the macroscopic type of UC-CRC might be helpful in determining tumor aggressiveness.
Chen ZW, Xu T, Yin ZH
… +6 more, Li QF, Shu YJ, Zhou XL, Zhao L, Sun MS, Liang FR
Int J Colorectal Dis
· 2025 Oct · PMID 41144022
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BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer-related mortality globally. While chemotherapy remains a cornerstone of CRC treatment, gastrointestinal (GI) toxicity-manifesting as abdominal pai...BACKGROUND: Colorectal cancer (CRC) is the second leading cause of cancer-related mortality globally. While chemotherapy remains a cornerstone of CRC treatment, gastrointestinal (GI) toxicity-manifesting as abdominal pain, diarrhea, constipation, and reflux-affects 40%-100% of patients, severely impairing quality of life. Despite the prevalence of these symptoms, there is a lack of effective non-pharmacological interventions. This study aims to evaluate the efficacy of electroacupuncture (EA) in alleviating chemotherapy-induced GI dysfunction in CRC patients. METHODS: In this multicenter, three-arm, randomized controlled trial (RCT), 231 CRC patients with post-chemotherapy GI symptoms will be centrally randomized to EA plus standard care, sham acupuncture (SA) plus standard care, or standard care alone. The EA and SA groups will receive three 30-min sessions over consecutive days, delivered by certified acupuncturists (EA: LI11, PC6, ST36 and ST37 with electrical stimulation; SA: non-acupoints with blunt-tip needles without stimulation). The primary outcome is the change in Gastrointestinal Symptom Rating Scale (GSRS) total scores from baseline to post-treatment (day 3). Secondary outcomes include GSRS subscale scores, Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scores, and Self-Rating Anxiety Scale/Self-Rating Depression Scale (SAS/SDS) scores. All outcomes will be assessed at baseline (T0), post-intervention (T1: day 3), and follow-up (T2: day 10). Statistical analysis will employ intention-to-treat linear mixed-effects models. CONCLUSION: This multicenter RCT is designed to generate high-quality evidence on the comprehensive efficacy of EA in addressing chemotherapy-induced GI toxicity in CRC patients. If proven effective, EA could provide a safe, non-pharmacological adjunct to standard care, helping to reduce symptom burden and improve patient adherence to chemotherapy. Trial registration ChiCTR2200062317. Registered on 1 August 2022.
Lauwereins L, D'Hoore A, Coeckelberghs E
… +10 more, Fieuws S, Wolthuis A, Bislenghi G, Van Molhem Y, Van Geluwe B, Debrun L, Devoogdt N, De Groef A, Asnong A, Geraerts I
Int J Colorectal Dis
· 2025 Oct · PMID 41125949
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PURPOSE: This study investigated the evolution of Low Anterior Resection Syndrome (LARS) over 2 years following Total Mesorectal Excision (TME) for rectal cancer. METHODS: In this prospective cohort study, patients were...PURPOSE: This study investigated the evolution of Low Anterior Resection Syndrome (LARS) over 2 years following Total Mesorectal Excision (TME) for rectal cancer. METHODS: In this prospective cohort study, patients were recruited from three Belgian hospitals between January 2017 and January 2021. The primary outcome was the evolution of LARS, assessed with the LARS score at 1, 6, 12, and 24 months postoperatively or after stoma closure. The proportion of patients in each LARS category (no, minor, major) was analyzed, and transitions over time were examined using Bowker's test of symmetry. The secondary outcome was health-related quality of life, measured using the Short Form-12 (SF-12) at the same time points. RESULTS: Of 180 patients who underwent TME for rectal cancer, 87 (48.3%) completed the LARS score at all time points. At 1 month postoperatively, 66 patients (75.9%) had major LARS, decreasing to 51 patients (58.6%) at 6 months (p = 0.028). No significant changes were observed thereafter (p = 0.43 and p = 0.45 for 6 to 12 months and 12-24 months, respectively). Among the 51 patients with major LARS at 6 months, 10 patients (20%) improved by 12 and 24 months. Between 1 month and later time points, approximately 60% remained in the same category, 30% improved, and 10% deteriorated. Mean SF-12 physical and mental scores were similar across LARS categories at all time points. CONCLUSION: The majority of spontaneous improvement in LARS occurred within the first 6 months postoperatively, with little improvement thereafter. These findings highlight the need for early proactive management rather than expectant follow-up.
Kutlu B, Benlice C, Seker ME
… +2 more, Kocaay AF, Kuzu MA
Int J Colorectal Dis
· 2025 Oct · PMID 41125942
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PURPOSE: There is no standardized classification system for defining segments of colon carcinoma within cancer registries. We aimed to conduct a systematic literature review on studies that specifically address colon can...PURPOSE: There is no standardized classification system for defining segments of colon carcinoma within cancer registries. We aimed to conduct a systematic literature review on studies that specifically address colon cancer and provide definitions for each segment. METHODS: Five authors conducted an independent systematic literature search of studies on colon cancer between 01/1992 and 11/2023. Only English-language original articles including cohort studies, case series, previous reviews, meta-analyses, and randomized clinical trials were considered for inclusion. Exclusion criteria were case reports, editorials, and letters. After identifying the relevant studies, those describing particular colon cancer segments were assessed. Whether or not oncologic outcomes were assessed, whether any definitions for particular colon cancer segments were used, were reviewed and extracted. RESULTS: A total of 9059 articles were screened, and 1143 of them were identified and included in the current study. Out of 1143 included articles, 130 defined the specific colon cancer segment. Distribution of included articles with definition ratios for each segment was as follows: Cecum (n = 2; 2.35%), ascending colon (n = 2; 1.94%), hepatic flexure (n = 2; 33.3%), transverse colon (n = 33; 42.85%), splenic flexure (n = 38; 58.46%), descending colon (n = 16; 8.04%), sigmoid colon (n = 34; 4.99%), and rectosigmoid colon (n = 16; 15.23%). A total of 397 articles reported long-term oncologic outcomes. CONCLUSION: Our study unveils discrepancies in the published literature, revealing that nearly 10% of the studies focusing on colon cancer provide various definitions for each colonic segment. Standardizing the definitions of colon cancer segments is essential to prevent the use of arbitrary definitions, which can result in inconsistency and hinder accurate outcome assessments.
Tan S, Zeng P, Liu S
… +7 more, Yang Y, Chen S, Zhang W, Li X, Liu D, Li Y, Xu C
Int J Colorectal Dis
· 2025 Oct · PMID 41117835
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BACKGROUND: The emergence of artificial intelligence (AI) has greatly promoted the development of the field of medical image analysis, but the potential benefits of AI-assisted colonoscopy and diagnosis (CADe/CADx) for t...BACKGROUND: The emergence of artificial intelligence (AI) has greatly promoted the development of the field of medical image analysis, but the potential benefits of AI-assisted colonoscopy and diagnosis (CADe/CADx) for the detection rate of colorectal adenomas and the histological diagnosis of polyps are still controversial and unknown. METHODS: We conducted a search on PubMed, Web of Science, Embase, and Cochrane, and the last search time was August 2024. We collected adenoma detection rate (ADR), polyp detection rate (PDR), and sessile serrated lesion detection rate (SSL). Paired analysis and network meta-analysis (NMA) were performed using R Studio. StataSE15.0 software was used for statistical analysis to calculate the sensitivity and specificity of CADx and conventional colonoscopy. RESULTS: We included a total of 64 studies, including 52 RCT studies and 12 clinical studies, with a total of 50,834 patients undergoing colonoscopy. The results showed that different adjuvant interventions had significant differences in the detection rate of adenoma compared with routine colonoscopy ADR [RR = 1.20, 95% CI (1.14, 1.26), P < 0.001], and the results were statistically significant. Among different CADe models and advanced optical imaging techniques, ENDOANGEL model-assisted colonoscopy is the most effective method for detecting colorectal adenomas and polyps (97.8%), and Endocuff-AI model-assisted colonoscopy is the most effective method for detecting sessile serrated lesions (94.4%). In the performance study of endoscopists with or without CADX-assisted diagnosis, the optical diagnostic sensitivity of colorectal adenomas was (88% VS 86%), specificity (78% VS 77%), and AUC area (91% VS 89%), and the study results showed no significant differences. CONCLUSION: ENDOANGEL model-assisted colonoscopy shows the best efficacy on both ADR and PDR, Endocuff-AI model-assisted colonoscopy shows the best performance on SSL, and compared with optical evaluation without CADx, real-time polyp assessment using CADx did not significantly increase the diagnostic sensitivity of neoplastic polyps during colonoscopy.
Li Y, Wang X, Wang X
… +3 more, Jia X, Ren M, Xu T
Int J Colorectal Dis
· 2025 Oct · PMID 41114835
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BACKGROUND: Desmoglein-2 (DSG2), a calcium-dependent transmembrane glycoprotein, serves as a critical mediator of intercellular adhesion by functioning as an integral component of desmosomal junctions. Aberrant expressio...BACKGROUND: Desmoglein-2 (DSG2), a calcium-dependent transmembrane glycoprotein, serves as a critical mediator of intercellular adhesion by functioning as an integral component of desmosomal junctions. Aberrant expression of DSG2 has been implicated in the pathogenesis of a diverse array of malignancies. However, the expression patterns and functional significance of DSG2 in the context of colon cancer (CC) remain inadequately characterized. Consequently, this study was designed to comprehensively elucidate DSG2 expression and evaluate its potential prognostic utility in CC. METHODS: Tumor specimens from 104 CC patients and 77 samples of adjacent paraneoplastic tissue were procured, accompanied by the corresponding clinicopathological data from the contributing patients. Immunohistochemical analyses were performed on all samples using tissue microarrays. Variations in DSG2 expression between CC tissues and adjacent paraneoplastic tissues, along with the association between DSG2 expression and clinicopathological parameters of CC, were evaluated using the χ2 test. The Cox proportional hazards regression model was utilized for both univariate and multivariate analyses, while survival curves were generated using the Kaplan-Meier method. All statistical computations and graph plotting were executed using R software (version 4.2.0). RESULTS: DSG2 expression was significantly lower in CC tissues compared to peri-cancerous tissues (P < 0.05). DSG2 expression exhibited significant correlations with tumor differentiation (P = 0.041) and distant metastasis (P < 0.05). Univariate Cox regression analysis indicated that overall survival (OS) in CC patients was significantly associated with tumor size (HR = 1.649, 95% CI: 1.007-2.700, P = 0.047), lymph node metastasis (HR = 2.102, 95% CI: 1.284-3.440, P = 0.003), distant metastasis (HR = 2.459, 95% CI: 1.502-4.026, P < 0.001), and DSG2 expression (HR = 0.399, 95% CI: 0.237-0.672, P = 0.001). Multivariate Cox regression analysis revealed that lymph node metastasis (HR = 1.872, 95% CI: 1.136-3.085, P = 0.014), distant metastasis (HR = 1.756, 95% CI: 1.024-3.011, P = 0.041), and low DSG2 expression (HR = 0.529, 95% CI: 0.305-0.916, P = 0.023) are independent prognostic factors for overall survival (OS). CONCLUSION: Diminished DSG2 expression is correlated with reduced survival rates in CC patients, suggesting that DSG2 could serve as a potential prognostic biomarker for CC.